SoonerCare proposes outpatient testing limits
Posted on: 2/15/19
The Oklahoma Health Care Authority has proposed a rule limiting expenditures for outpatient diagnostic testing, laboratory, and radiological services for most adults in the SoonerCare (Medicaid) program to $500 per year.
The rule allows for “extensions” of the $500 limit when medically necessary. The extension procedures do not apply to individuals under 21 years of age, or in hospital emergency rooms. Extension procedures do not apply to magnetic resonance imaging (MRI), magnetic resonance angiography (MR), positron emission tomography (PET) scans, cardiac catheterization procedures, pregnancy-related services, and several other categories of outpatient care.
Some diagnoses are considered to be categorically medically necessary and do not require review for medical necessity. These are malignancies, human immune-deficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) and end-stage renal failure. All other diagnoses are subject to review before benefits can be extended.
The rule is posted for public comment through March 9, 2019. To review the rule, and to comment,
click here, and select “OK SPA 19-05 Limitation of Outpatient Laboratory, X-Ray, and Select Machine Testing Services for Adults.”
(Rick Snyder)